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CITY OF CyUPERTINO
'
CO3RT11XCTVR�It�,,4RMA'CIO,N�"
BUILDING DIVISION' PERMIT
^ r
BUILD[ ESS: RESS:
!.)/l� ISA MAR DR
JM DRAIN CLEANING AND
PERMrr NO.
08090014
OWNER'S NAME:
FERMn LSSUEDATE
_ JARA L,:I:ONEL F AND KAREN K
1725 ROGERS AVE STE C
09/04/2008
]NE
SANITARY NO. CONTROL NO.
(408) 903-8184
ARCHRECT/ENGINEER:
BUILDING PERMU INFO
BLDG ELECT PLUMB MECH
0 0
LICENSED CONTRACIOR9 DECLARATION
Ransed Chapter 9
Job Description
I hereby a1Bm that 1 am under Provisions of (commencing
with Section 7000) orDlvision 3 otthe Busty and Proxi mime Code. and my license is
COPPER REPI:PE FRM HSE SHT-OFF TO ENTIRE HSE &
in full force and e
Liana mfY.P
RPLC -
�w RCHrrECrSECD LA10 I
40 CAL WTR IiTR
1 undcmwd my plans shall Ise used as public score
i
Licensed Pmfasioml
OWNER -BUILDER DECLARATION
1 thereby (Rrm that 1 License law for de
exempt from the Cauhmar
o
!allowing wan. . 1. Busrcm and Pm(asiom Cods: My city m comely
170313,
Permit ri repair a ntum
mgmsut a remail re CarnWC4 two imfor
h Permitdemolat
prior t
such ed canonical
csof for Conlan lei's Uwas signed (Char
re,dt e provisions (Charm, 9
thathe its censed purse pursuant Nc
wlneiauanwit para canusi.
Sq. Ft. Floor Area
Valuation
or Divatu 3de aunml,w
.7 of Buderss Code)
Cam) or
D ands
with Scctim 10nd
$8045
that he is cog
for the W prion. y vi
the f r alleged exemption. My vlolakn of
Nal io u exempt therefrom and de
be
Seeder 7031.5 ary Faro
doll roe permh subjects Nc rpplkant w r civil penalty of
�,p� Number
36910023
Occu ane T e
P Y• YP
not mom man Rte hWme cellon (ism).
n land
.•l7•lf'
0 I,uowerofNep perty.mmy=PloyeuwithmguuNeksokcanpemdon,
will an mewart. and Immune. is notkweded or offered rarsak (Sec. 7014, Bumem
and Proretaaan Cade: The Customer Liaise Law does rot apply w an awrer, of
Required Inspections
property who Wilas orimprotn dwpaam. am wwdoessueh mala himselfer Wougb his
awn employee, pmHmd that such impronaenu ere not inended aroffered formic B,
hawenr, the building or Improvement is said within am year of cmapkdon. the owner.
Wilda will Iran Ne burden of paring that he did not Wild a happen fur purpose of
me.).
❑ I. m owner of the property. am exclusinly contracting with IiccaW mm,aaM in
construct de Project (Sec. 7044. Business and Profesdom Cade:) The Cm ewer's U,
ecere Law dma mol apply to an owner a proPaty who Wilds or impwvee Iweon. amM .
for such wid,conuacw,(q liaised paramountB&PCoConsractots
who mnuacu,under
/']Lkeme
law.
Sate
exmpt undo See ,Bak PC fm N4SAN
Owner DaN
��\\\\\jll"J/1(////❑lam
�'�
WORKERS COMPENSATION DECLARATION
1 hereby aff miler penally or pare,, mw of de following descriptions
`--C'h
I ban and will msinmia a Cenificaw ofComem to self-immrt forwaftesf empea.
on, as provided for by section 3700 or the labor Cade. for de Performance of the
weak for which this permit is Leena
n and will maintain WorkCra Compensation Insurance. m mQNRd by Section
-
m of the lather Coda, for de
the performance of mark fm which thin permit is issued.
M orkera Compewtion lmunms carrier and Policy number an;
(]„ten Policy No.:
CERTIFICATE OF EXEMPTION. FROM WORKERS'
COMPENSATION INSURANCE
(Thuxmm reed not W completed iflW permit is farm hundred author (3100)
or[a .)
I c rrifv that In the Performance of ft wort for which Ni it u issue.I shell not
r
employ anypersen in any amore yen ase ere Wortms' Compensadm
Lana o(Cal'f ryi,aa / �/—
AooBcam
NOT1C P nwdtiag this Ceniliau: or Exemption, ym shauW
anbjttl w theWmkcts Compeamtion provisions; of de labor Corfu you ata
forthwith comply with such provision or this permit shall Inc dcemed ranked.
CONSIRvcnON LENDING AGENCY
1 Wreby rl@a that dere u a cmuatcdnn landing agmey for the pareamma of
dse wart far which Nis permit is issued (Sec 3097, Civ. C.)
Landoes Name
l<a ices Address
I certify that I ban hand this application W two that the awn i armmmen is
correct. I agree to comply with WE city and coaly amNarues and ate laws miming to
Wilding wasusumion, and hereby authari,e re,reentetiva of Nu city w anon, upon de
awn-rommored pmpcny fm ktspemim poop a,,
(We) agme to ern, indemnify and keep hamleas the City of Cupertino .pint
liabilities, jedgacnts. costs and apeman which may in any way accme,gsimt said City
60
I. cmvcquerea of the granting of Nu permit.
'
APPLICANT UNDER STA 1DSAND WILL COMPLY WITH ALL NON -POINT
Issued by: Date '3 -e_"
SOURJmxrll
Re -roofs
p
1 • V-06
ssyCre of FanDate
HAZARDOUS
RDOHAZAtrllMATERIALSUS MATERIADISCLOSURE
Type of Roof
Willy applicanto,futum Wildingre handle
Chapter9.12.
m deRmd by IW Cupenim Municipal Code. Chapter 9.13. W Ne HdN and Wely
Health and
cam, Saba zss32(r37
❑ll
All roofs shall be inspected prior to any roofing material being installed.
�No
Will dw applicant er f tum Wilding aavpant raw cauiPmmt m sarin, Mich
If a roof is installed without first obtainingan inspection, I agree to remove
P
I hvvdous air canuminanN as derined by de Bay Area Air Quality Matsgemem
all new materials for inspection.
❑Yan Nm
I ban mad the haamrwmarerials nwaimmaw unmr hapterb.95ofdeCalifar-
maHanldkSafcly Codc. Scctiom25M5.25533 and 25534.1 undcaund thuifthe Wilding
dost eat cu mq'tma�m�. ten my mapomihililY w notify Ne arupant of do
..Lmmah¢a
mquircmc min k a poi err, Certife,w afOmpwey.
'9- y O
Signature of Applicant Date
All roof coverings to be Class r'Ii" or better
Dw_ an,cd,put Data
6 ITEMS OF 6
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub:
Blk: Lot:
APN ........:
36910023.00
DATE ISSUED.......:
09/04/2008
RECEIPT #.........:
BS000005985
REFERENCE ID # ...:
08090014
SITE ADDRESS .....: 19745 LA MAR DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
YE"THOD OF PAYMENT
------------------
CREDIT CARD
TOTAL, RECEIPT :
AMOUNT
---------------
270.13
---------------
270.13
VOICE ID DESCRIPTION
-------- -------- --------------
I.06 SEWER & WATER
507 FINAL PLUMBING
REFERENCE NUMBER
--------------
MC
VOICE ID DESCRIPTION
--- ----------------------------
301 ROUGH PLUMBING
OWNER ............:
JARA LIONEL F AND
KAREN
K
ADDRESS ..........:
19745 LA MAR DR
CITY/STATE/ZIP
...:
CUPERTINO CA,
95014-3308
RECEIVED FROM ....:
JOSE L MENDEZ
CONTRACTOR .......:
JOSE MENDEZ LIC
# 29513
COMPANY ..........:
JM DRAIN CLEANING
AND PLUMBING
ADDRESS ..........:
1725 ROGERS AVE STE
C
CITY/STATE/ZIP
...:
SAN JOSE, CA 95112
TELEPHONE ........:
(408) 903-8184
• FEE 7:D
UNIT
- --
QUANTITY
------------- ----------
AMOUNT PD -TO
-DT
THIS REC
NEW BAL
1.BPWATER
UNIT
1.00
--------------------
40.79
----------
0.00
40.79
----------
0.00
IBSEISMICR
VALUATION 8,045.00
0.90
0.00.
0.90
0.00
1.PLMBINSP
HOURS
1.00
122.38
0.00
122.38
0.00
1.13PERMITFE
FLAT RATE
1.00
40.79
0.00
40.79
0.00
1PRWHEATR
UNITS
1.00
24.48
0.00
24.48
0.00
1.TRAVDOC
FLAT RATE
1.00
40.79
0.00
40.79
0.00
TOTAL PERMIT
270.13
0.00
270.13
0.00
YE"THOD OF PAYMENT
------------------
CREDIT CARD
TOTAL, RECEIPT :
AMOUNT
---------------
270.13
---------------
270.13
VOICE ID DESCRIPTION
-------- -------- --------------
I.06 SEWER & WATER
507 FINAL PLUMBING
REFERENCE NUMBER
--------------
MC
VOICE ID DESCRIPTION
--- ----------------------------
301 ROUGH PLUMBING
CUPEkTINO
L
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
PERMIT APPLICATION FORM
u0ogOvly
APN # . 2 �P/� t Oba 3 . 00
Date:
Building Address:
a
Owner's Nam / Phone #:
ti/ 2�Sv
Contractor:.J� &A ATI( L tR N T N <iPB X03 /
Fax #:
Contact:J Phone #:
�,o� 9o��/may
Fax #:
Contractor License #: 1 n
Cupertino Business License #: a , q
l 513
Job Description: �p�/� �j�i�i OCiS e w t O O
Commercial re -pipe per fixture
Residential_ Commercial ❑
Valuation:/�
Size:
Project Express . Standard Major
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index.
Green Building Points:'
Quantity
FeeID
Fee Description
Fee
Grou
Permit Type
1PCSEWER
Commercial building
sewer/sanitary sewer
P
1CPSS
1BPREPIPE
Commercial re -pipe per fixture
P
1CPRP
1PGASCOM
Commercial Gas Piping System
1-4 Outlets
P
1BSEISMICOM
Seismic Commercial
p
/
1BSEISMICR
Seismic Residential
P
1PRSEWER
Residential building
sewer/sanitary sewer
P
1RPS S
Son
CIN OF
CUPERTINO
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
1PRREPIPE
Residential re -pipe per fixture
P
1RPRP
1BPWSVCS
Water Service
P
1CPWS or
1R -PWS
1PPRSEWG
Private'Sewage Disposal System
P
IPCESS
Cesspool
P
IBPWATER
Install/alter Water Pipe
P
1BPFIXTURE
Plumbing Fixture
P
1PGASRES
Residential Gas Piping System
1-4 Outlets
P
1BPGAS
Gas Piping System 5+ Outlets
P
1
1PPERMITFEE
Plumbing Permit Fee Issuance
P
1PLMBLNCK
Plumbing Plan Check
P
f
1PLMBINSP
Other Plumbing/gas Insp.
P
1TRAVDOC
Travel & Documentation Fee
B
1BUSLIC
Business License
B
Revised 6-16-08
•
•
0
L
\J
E
Plan Review Process Work Book Page -12-Revised 3/25/08
Green Building Plan Check
Index of Green Building
Points/Categories
A.
Category
Example of an Index or Table of Green
Plan Sheet or Page
Points
Building Points Categories that must be
shown and referenced on the Project
Plans See below
B.
Site
9.
Install H.E. Irrigation, (details/spec)'
L-1
2 points
11. Permeable Pavin Note
L-1
2 points
C.
Foundation
1.
Use 15 % Flyash Concrete, (note)
S-1
5 points
D.
Structural
3.
Uses Wood I -Joist, (See Spec.)
S-2
2 points
5.
Use Truss with heels, (detail)
S-2
2 points
6.
B. OSB Sheathing, detail
S-2
2 Points
E.
Ext. Finish
1.
Composite Decking, (Note/Spec.)
A-3
2 points
4.
B. Fiber Cement Siding, (Note/Spec.
A-4
2 points
F.
Plumbing
1.
Insulate all H.W. pipes, (Note/Spec.)
P-1
2 points
5.
Tankless W.H., (Note/Spec.)
A-2
2 points
11. A 2500 Gal. Tank, (Note/Spec
L-1
10 points
G.
Electrical
4.
E. Ceiling Fans, (Note/Spec.)
A-3
4 points
H.
Appliances
1.
Energy Star Dishwasher, (Note/Spec.)
A-3
1 point
3.
Energy Star Ref ri erator, Note/S ec.
A-3
1 point
P.
Other
1.
List Green Features on Plans
A-1
1 point
TOTAL POINTS
40 points
\J
E
Plan Review Process Work Book Page -12-Revised 3/25/08
D
Green Points Rating System for Remodeling Projects
Due to the diversity of remodeling project types, assigning a'total points' value to a project to be considered environmentally friendly is
not feasible. However, 25 measures have been highlighted to signify that every effort should be made to incorporate them into your
projects. These items have been chosen based upon their impact on the environment and the health of the home in coordination with
ease of implementation and relative low cost. These measures can be used as a starting point for 'greening' your project.
11. Recycle Job Site Construction & Demolition Waste
0
D
0
r
0
0
r
il
65%=1 point; 75%= 2 points; B0%= 4 points
up to 4 Resource pt;
2. Salvage Reusable Building Materials
4 Resource pts
y=yer
3. Remodel for Mixed Use, Adaptive Reuse, and
(For every 10% of FSC lumber used = 2 points, up to 10)
up to 10 Resource pts.
Histodc Preservation
4 Resource pts
y=yer
4. Protect Native Soil
2 Resource pts
Y --ye!
5. Minimize Disruption of Existing Plants & Trees
1 Resource pt
y=ye!
6. Implement Construction Site Stormwater Practices
2 Resource pts
y=ye:
7. Protect (Nater Quality with Landscape Design
2 Resource pts
y=ye:
.B. Design Resource -Efficient Landscapes and Gardens
4 Resource pts
y=ye!
9. Reuse Matenals/Use Recycled Content Materials
for Landscape Areas
2 Resource pts
y=yes
10. Install High -Efficiency Irrigation Systems
2 Resource pis
y=ye.
11. Provide for On -Site Water Catchment / Retention
2 Resource pts
y=yes
B. Foundation
4 Resource pts
y=yes
1. Incorporate Recycled Flyash in Concrete
3 Resource pts
25% Recycled Flyash = 2 points; Add 1 point for every 0°/
y=yes
• , increase of flyash, up to 5 points
up to 5 Resource pts
2. Use Recycled Content Aggregate
2 Resource pts
y=yes
3. Insulate Foundation/Slab before backfill
3 Energy pis
y=yes
C. Structural Frame
0
D
0
r
0
0
r
il
1. Substitute Solid Sawn Lurnber with Engineered Lumber '
3 Resource pts
2. Use FSC Certified Wood for framing
y=ye-
(For every 10% of FSC lumber used = 2 points, up to 10)
up to 10 Resource pts.
3. Use Wood I -Joists for Floors and Ceilings
2 Resource pts
y=yes
4. Use Web Floor Trusses -
2 Resource pts
y=yes
5. Design Energy Heels on Trusses 6" or more
2 Energy pts
y=yes
6. Use Finger -Jointed Studs for Vertical Applications
2 Resource pts
y=yes
7. Use Engineered Studs for Vertical Applications
2 Resource pts
y=yes
6. Use Recycled Content Steel Studs for Interior Framing
2 Resource pts
y=yes
9. Use Structural Insulated Panels (Sips)
a. Floors
3 Energy pts
y=yes
b. Wall
3 Energy pts
y=yes
c. Roof
3 Energy pts
y=yes
10. Apply Advanced Framing Techniques
4 Resource pts
y=yes
11. Use Reclaimed Lumber for Non Structural Applications
3 Resource pts
12. Use OSB
y=yes
a. Subfloors
b. Sheathing
1 Resource pt
y=yes
•
1 Resource of
y=yes
0
D
0
r
0
0
r
il
0 0
0
1. Use Sustainable backing Materials
a. Recycled content
b. FSC Certified Wood
'2. Use Treated Wood That Does Not Contain Chromium/Arsenic
:3. Install House Wrap under Siding
14. Use Fiber -Cement Siding Materials
E. Plumbing
1. Install Water Heater Jacket
2. Insulate Hot and Cold Water Pipes
I3. Retrofit all Faucets and Showerheads with Flow Reducers
a. Faucets (1 point each, up to 2 points)
b. Showerheads1
( point each, up to 2 points)
I4. Replace Toilest with Ultra -Low Flush Toilets
(1 point each, up to 3 points)
5. Install Chlorine Filter on Showerhead
6. Convert Gas to Tankless Water Heater
7. Install Water Filtration Units at Faucets
(2 points each, up to 4 points)
8. Install On -Demand Hot Water Circulation Pump
r. nec[ncai
,1. Install Compact Fluorescent Light Bulbs (CFLs)
(6 bulbs=2 points, .10 bulbs =3 points, 12 bulbs = 4 points)
2. Install IC -AT Recessed Fixtures with CFLs (1 point each, up to
5 points)
3. Install Lighting Controls (1 point per fixture, up to 4 points)
4. Install High Efficiency Ceiling Fans with CFLs
(1 point each, up to 4 points)
G. Appliances
i1. Install Energy Star Dishwasher
2. Install Washing Machine with Water and Energy
Conservation Features
13.Install Energy Star Refrigerator
�4. Install Built-in Recycling Center
H. Insulation
1. Upgrade Insulation to Exceed Title 24 Requirements
a. Walls
b. Ceilings
2. Install Floor Insulation over Crawl Space
3. Install Recycled -Content, Fiberglass Insulation with
No Added Formaldehyde
4. Use Advanced Infiltration Reduction Practices
5. Use Cellulose Insulation
a. Walls
b. Ceilings
6, Alternative Insulation Products (Cotton, spray -foam)
a. Walls
o. ceilings
3 Resource pts
y=y,
3 Resource pts
y --y,
1 IAQ/Health pt
y=y
1 IAQ/Health pt
y=y
1 Resource pt
y --yes
1 Energy pt y=yes
2 Energy pts y=ye<-
Up to 2 Resource pts
Up to 2 Resource pts
Up to 3 Resource pts
1 IAQ/Health pt y --yes
4 Energy pts y=yes
Up to 4 IAQ/Health pts
4 Resource pts y --ye!
Up to 4 Energy
Up to 5 Energy
Up to 4 Energy
Up to 4 Energy pts.
1 Energy pt
,
1 Energy pt
1 Energy pt
3 Resource
2 Energy pts
o
a
o
4 Energy pts
y=yes
31ADJHealth pts
y=yes
2 Energy pts
y=yes
4 Resource pts
y=yes
4 Resource pts
Up to 4 Energy pts.
1 Energy pt
,
1 Energy pt
1 Energy pt
3 Resource
2 Energy pts
y=yes
2 Energy pts
y=yes
4 Energy pts
y=yes
31ADJHealth pts
y=yes
2 Energy pts
y=yes
4 Resource pts
y=yes
4 Resource pts
y=yes
4 Resource pts
y=yes
4 Resource pts
y=yes
•
•
1. Install Energy-Efficient Windows
• a. Double-Paned
b. Low-Emissivity (Low-E)
c. Low. Conductivity Frames
�2. In Low Heat Transmission Glazing
J. Heating Ventilation and Air Conditioning
1. Use Duct Mastic on All Duct Joints
2. Install Ductwork within Conditioned Space
3. Vent Range Hood to the Outside
4. Clean all Ducts Before Occupancy
5. Install Solar Attic Fan
6. Install Attic Ventilation Systems
7. Install Whole House Fan
8. Install Sealed Combustion Units
a. Furnaces
b. Water Heaters
9. Replace Wall -Mounted Electric and Gas Heaters with
Through -the -Wall Heat Pumps
10. Install 13 SEER/11;EER or higherAC with a TXV
11. Install AC with Non -HCFC Refrigerants
1 Energy pt
2 Energy pts
2 Energy pis
1 Energy pt
2 Energy pts
y=yes
3 Energy pts
y=yes
1.IAO/Health pt
y --yes
21AQ/Health pts
y=yes
2 Energy pis
y --yes;
1 Energy of
y=yes
4 Energy pts
Y --yes
31AQ/Health pts y=yes
31AQ/Health pts y=yes
3 Energy pts
Y --yes
3 Energy pts
y=yes
2 Resource pts
y --yes;
12. Install 90% Annual Fuel Utilization Efficiency (AFUE) Furnace
2 Energy pts
13. Retrofit Wood Burning Fireplaces
1. Pre -Plumb for Solar Water Heating
a. Install EPA certified wood stoveslnserts
1 IAQ/Health pt
• J. Install/Replace Dampers
1 Energy of
c. Install Airtight Doors
1 Energy pt
14. Install Zoned, Hydronic Radiant Heating
3 Energy pis
15. Install High Efficiency Filter
41AQ/Health pts
16. Install Heat Recovery Ventilation Unit (HRV)
5 IAQ/Health pts
17. Install Separate Garage Exhaust Fan
3 IAQ/Health pts
K. Renewable Energy and Roofing
1. Pre -Plumb for Solar Water Heating
4 Energy pts
y=ye:
2. Install Solar Water Heating System
10 Energy pts
y=ye.
3. Pre -Wire for Future Photovoltaic (PV) Installation
4 Energy pts
y=yes
4. Install Photovoltaic (PV) System
(1.2 kw = 6 points, 2.4 kw =12 points, 3.6 kw =18 points)
Up to 16 Energy
pts
6. Select Safe and Durable Roofing Materials_
1 Resource pt
y=yes
7. Install Radiant Barrier
3 Energy pts
y=yes
L. Natural Heating and Cooling
1. Incorporate Passive Solar Healing 5 Energy pts
2. Install Overhangs or Awnings over South Facing Windows 3 Energy pts
3. Plant Deciduous Trees on the West and South Sides 3 Energy pts
1. Use LowMo-VOC Paint
1 IAQ/Health pts
y=yes
2. Use Low VOC, Water -Based Wood Finishes
2 IAQ/Health pts
y=yes
F3. Use Low/No VOC Adhesives
3 IAQ/Health pts
y=yes
4. Use Salvaged Materials for Interior Finishes
3 Resource pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
5 IAQ/Health pts
y=yes
Formaldehyde
6IAQ/Health pts
y=yes
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ/Health pts
y=yes
1. Seal all Exposed Particleboard or MDF
4 IAQMealth. pts
y --yes
8. Use FSC Certified Materials for Interior Finish
4 Resource pts
y=yes
9. Use Finger -Jointed or Recycled -Content Trim
1 Resource pts
y=yes
10. Install Whole House Vacuum System '
31AQ/Health pts
y --yes
N. Flooring
1. Select FSC Certified Wood Flooding
6 Resource pts
y=yes
[2. Use Rapidly Renewable Flooring Materials
4 Resource pts
y=yes
3. Use Recycled Content Ceramic Tiles
4 Resource pts
y=yes
4. Install Natural Linoleum in Place of Vinyl
5 IAQ/Health pts
y=yes
5. Use Exposed Concrete as Finished Floor
4 Resource pts
y=yes
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
Y --yes
Total Points Available:
Total Points Project Received:
•
1401 1301 57
01 0[--] •
G' !_3uidelinesrremodelers�greenpoin!sfra2.12.Obprorecledzls_ ��
J
�. Community Development
10300 Torre Avenue
''% Cupertino CA 95014
.sow Telephone(408)777-3228
CITY OF Fax (408) 777-3333
�UPEkTINO
Building Department
s
JOB ADDRESS:
PERMIT #
OWNER'S NAME•
PHONE # S
GENERAL CONTRACTOR:S
FAX #
I am not using any subcontractors•
ignature Date
Please check applicable subcon ctors and complete the following information:
61
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature
Date